Patients
We performed a cross-sectional analysis of reported demographics, medical history, and medications from 1,237 moderate-to-severe AD patients enrolled from April 2nd 2020 through January 31st, 2021 in a prospective registry related to COVID-19 in the Department of Dermatology at the Icahn School of Medicine at Mount Sinai. Patients were enrolled under institutional review board-approved consent, and the study was conducted according to the Declaration of Helsinki. The electronic medical record was queried for all related ICD10 codes and each patient chart was reviewed to ensure inclusion criteria were met. Patients were enrolled at the time of clinical visit, when applicable, or enrolled over the phone. Inclusion criteria included being older than 9 years of age with a diagnosis of moderate-to-severe atopic dermatitis, defined as currently or previously being on systemic therapy (including dupilumab, phototherapy, or oral immunomodulatory medications), or as candidates for systemic therapy.
Patients were asked about past medical history, medications, demographics (i.e., age, gender, and self-reported race), as well as the presence and duration of individual COVID-19-related symptoms, including objective or subjective fever, sore throat, cough, congestion, headache, fatigue, anosmia, dysgeusia, dyspnea, nausea, vomiting, diarrhea, anorexia, and skin changes. Based on the symptoms described, each patient was given a COVID-19 symptom severity score from 0-5: 0: “asymptomatic”; 1: “mild disease” (no fever, no dyspnea, resolving in <7 days, resembling a common cold); 2: “moderate disease” (some fever and/or cough, or other lower respiratory symptoms, resolving at home in 7-14 days); 3: “severe disease” (pneumonia, required hospitalization, but resolved without intubation); 4: “very severe disease” (required hospitalization, intubation, and other supportive measures); 5: “fatal.”
One thousand two-hundred and thirty-seven patients were included in the final analysis, out of 1,357 patients enrolled. In the final analysis, we excluded patients treated concomitantly with dupilumab and other systemic therapies (due to the hypothesis that dupilumab would reduce symptom severity compared to other systemic treatments), patients on dupilumab for <2 months (in order to allow for the proposed effects of dupilumab to manifest), and patients on additional immunomodulating therapies for other skin or extracutaneous indications besides AD (including TNFα and IL-23/IL-17 antagonists).